[Standardized diagnosis and treatment of azoospermia: a report of 1027 cases].

OBJECTIVE

To constitute an appropriate procedure for clinical diagnosis and treatment for men with azoospermia in China.

METHODS

Following a procedure which combined the recommendations from WHO, European Association of Urology (EAU), American Urological Association (AUA), American Society for Reproductive Medicine (ASRM) with our own experiences, 1 027 patients with azoospermia were divided into different subtypes according to patients' case histories and outcomes of various routine and specialized examinations. Then appropriate treatments were chosen according to the diagnostic subtypes.

RESULTS

There were 516 cases of obstructive azoospermia, 315 of non-obstructive azoospermia and 150 of combined (obstructive and non-obstructive) azoospermia and 46 of azoospermia with special aetiology. Of the 96 patients who adopted surgical intervention, 28 underwent transurethral resection of the ejaculatory ducts, 10 vasovasostomy and 58 vasoepididymostomy. Of the 45 patients who adopted drug intervention, 16 with inflammatory obstructive azoospermia were treated with antibiotics and 29 with hypogonadotropic hypogonadism were treated with hormonal therapy. Of all the subjects, 789 patients chose in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) and 142 chose artificial insemination of donor (AID) or adoption.

CONCLUSION

(1) A standard procedure should be established for the diagnosis, classification and treatment of azoospermia; (2) Special examinations and treatments should be given to cases of azoospermia with special aetiology; (3) According to the diagnosis and the patients' conditions, the most appropriate treatment options should be recommended to them; (4) The hereditary factors in azoospermia should be seriously considered, and a genetic work-up and counseling should be offered in such cases.